Eyelid Surgery

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Pathologic eyelid drooping, also called ptosis may occur due to trauma, age, or various medical disorders. This condition can affect one (unilateral ptosis) or both (bilateral ptosis) eyes, it may come and go, or it might be permanent. It can be present at birth (known as congenital ptosis) or you can develop it later in life (known as acquired ptosis). Depending on the severity of the condition, drooping eyelids can block or greatly reduce vision depending on how much it obstructs the pupil. In most cases, the condition will resolve, either naturally or through medical intervention.

Description of blepharoplasty


Every year, hundreds of thousands of men and women choose blepharoplasty to improve the way they look. Droopy eyelids can make you look older and can also impair vision. Blepharoplasty corrects these problems. Blepharoplasty includes surgery to repair droopy eyelids and involves removing excess skin, muscle and fat.

Causes of drooping eyelids


Drooping eyelids may be due to a variety of conditions include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, or a brain tumor or other cancer that affects nerve or muscle reactions. Below are some common causes.
• Aging: One of the most common causes of drooping eyelids is the age and it affects both sides. It causes stretching of the levator muscle of the eye and stretching and wrinkling of the skin all around the eyes.
• Congenital droopy eyes: Congenital droopy eyes is a situation where droopy eyelid takes place in the newborn baby and it may be because of the underdevelopment of the levator muscle of the eye
• Nerve disorders: Cranial nerve and brain injuries due to any reason can cause ptosis as it affects the nerve supply to the muscles of the eyes and eyelids. Brain tumor, stroke, aneurysm and long-term diabetes may also cause this to happen.
• Muscle disorders: muscular dystrophy is an inherited muscle disease that affects the movement of the eyes and it may also cause issues with eyes. Droopy eyes may be one of the symptoms of this disease.
• Eye injury: trauma to the eye as an assault or an accidental injury to the eye may also result in ptosis.

Symptoms of drooping eyelids


• Drooping of one or both eyelids
• Difficulty in opening the eye
• Eye fatigue
• Misaligned eyes
• Double vision
• Increased tearing
• Dry eyes
• Interference with vision (if the drooping is severe)

Diagnosis of drooping eyelids


He or she will ask you questions about your symptoms, family medical history, and personal medical history. Although the visual appearance of droopy eyes is the first step in ptosis diagnosis, regular eye exams are also important to check whether droopy eyelids are impairing one’s vision. Blood tests may also be used to check for diabetes or autoimmune diseases that could be causing ptosis. Lastly, with an X-ray, a doctor can detect any structural abnormalities in the eyes that could be contributing to the problem. CT-scan and MRI could be order to check for neurological problems.

Candidates for Blepharoplasty


The best candidates for eyelid surgery are men and women who are physically and mentally healthy, with realistic expectations about the results of surgery. Eyelid surgery is usually performed on patients over 35, but if hereditary influences cause excessive drooping, the procedure may be an option for younger people. Medical conditions such as hypothyroidism or Graves’ disease, dry eye or tearing problems, high blood pressure, diabetes, cardiovascular disease, and other circulatory disorders raise the risks of eyelid surgery and should be discussed with your surgeon prior to the procedure.

Blepharoplasty consultation


During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for eyelid surgery and clarify what blepharoplasty can do for you. Once the surgeon understands your goals, he or she may suggest additional or related procedures. You should come to the consultation prepared to discuss your complete medical history.

Types of blepharoplasty


There are three types of blepharoplasty; upper, lower and combination blepharoplasty. Upper blepharoplasty targets eyelids and resolves issues including droopiness, puffiness  and wrinkles. Lower blepharoplasty focuses on under eye areas including; dark circles , under eye bags and pockets of fat beneath the eye. Combination blepharoplasty addresses issues associated with upper and lower eyelids in order improve appearances.

Upper eyelid blepharoplasty

The procedure is conducted under local or general anesthetic and can last up to an hour. In upper eyelid surgery, the surgeon first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat is removed or repositioned, and then the loose muscle and skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.
Lower eyelid surgery

Lower eyelid surgery could be performed under local or general anesthetic and takes about two hours. In lower eyelid surgery, the surgeon makes the incision in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Eyelid puffiness caused primarily by excess fat may be corrected by a trans-conjunctiva blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed. When sutures are used to close this kind of incision, they are invisible to the eye. They are also commonly self-dissolving and leave no visible scar.

After the procedure

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Sterile bandages are applied, and surgeon might prescribe ointment for dry eyes.

Recovery


Immediately after surgery, there will be some mild swelling and possibly some bruising. This will get a little worse over the next 2 days before it gets better. Blepharoplasty causes very little pain. It is unlikely you will need to take any pain medications the day after surgery. You will ice your eyes for the first 2 days after surgery and apply an antibiotic ointment such as Bacitracin to the incision line. You should refrain from exercising or strenuous activity for one to 2 weeks. Stitches are usually removed in 5-7 days.

Prognosis


Blepharoplasty is commonly very effective in resolving congenital and acquired ptosis. Nighttime eye cream might be prescribed if surgery has resulted in eyes to remain slightly open during sleep.

Cost


The cost of eyelid surgery varies depending on the treatment you are receiving, experience of surgeon, and how many eyelids you are seeking treatment for.

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